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Attempted suicide
A suicidal act that does not end in death is commonly called a "suicide attempt" or a "suicidal gesture." In the technical literature people prefer the use of the neologism parasuicide, or describe such acts as "deliberate self-harm" (DSH) – both of these terms avoid the question of the intent of the action. Those who attempt DSH are, as a group, quite different from those who actually die from suicide. DSH is far more common, and the majority are amongst females aged under 35. They are rarely physically ill and while psychological factors are highly significant, they are rarely clinically ill and severe clinical depression is uncommon. Social issues are key — DSH is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking, criminal behavior and violence. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. DSH may also result from an inner conflict between the desire to end life and to continue living. Epidemiology Nearly half of all suicides are preceded by an attempt at suicide that does not end in death. Those with a history of such attempts are significantly more likely eventually to end their own lives than those without. A suicidal act that did not end in death is commonly called a "suicide attempt" or a "suicidal gesture". In the technical literature people prefer the use of the neologism parasuicide, or describe such acts as "deliberate self-harm" (DSH); both of these terms avoid the question of the intent of the action. Those who attempt to harm themselves are, as a group, quite different from those who actually die from suicide. Self-harm is far more common, and the majority are amongst females aged under 35, though it occurs in men and women of all ages. Although they are rarely physically ill, they are considered psychiatrically unstable. In the US, the NIMH reports there are 11 nonfatal suicide attempts for every suicide death.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS): http://www.cdc.gov/ncipc/wisqars The American Association of Suicidology reports higher numbers, stating that there are 25 suicide attempts for every suicide completion.USA suicide 2006 Official final data: JL McIntosh for the American Association of Suicidology 2009. Many figures there taken from Reducing suicide: a national imperative, Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, editors. By these numbers, of the people who attempt suicide, approximately 92-96% survive the attempt. In contrast to suicide mortality, rates of nonfatal self-injury are consistently higher among females.Nock et al. (2008). Suicide and suicide behavior. Epidemiologic Reviews, 30, 133-154. doi:10.1093/epirev/mxn002 Social issues are key—DSH is most common among those living in conflict with their families, with disrupted childhoods and a history of drinking, criminal behavior, violence, and abuse are associated with DSH, though this is not always the case for a majority of those that DSH. Individuals under these stresses become anxious and depressed and then, usually in reaction to crisis, be it considered small or huge to others, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. Self-harm may also result from an inner conflict between the desire to end life and to continue living. Parasuicide and Self-injury Without commonly agreed-upon operational definitions, some suicidology researchers regard many suicide attempts as parasuicide or self-injurious behavior, rather than "true" suicide attempts. Methods Some suicide methods have higher rates of lethality than others. The use of firearms results in death 90% of the time. Wrist-slashing has a much lower lethality rate, comparatively. 75% of all suicide attempts are by self-poisoning, a method that is often thwarted because the drug is nonlethal or is used at a nonlethal dosage. These people survive 97% of the time. Repetition A nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide.Harris EC, Barraclough B: Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170:205–228 Suicide risk among self-harm patients is hundreds of times higher than in the general population.Owens D, Horrocks J, House A: Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry 2002; 181:193–199 It is often estimated that about 10-15% of attempters eventually die by suicide.Suominen et al. (2004). Completed Suicide After a Suicide Attempt: A 37-Year Follow-Up Study. Am J Psychiatry, 161, 563-564. The mortality risk is highest during the first months and years after the attempt: almost 1% of individuals who attempt suicide die within 1 year.Hawton K, Catalan J. Attempted suicide: a practical guide to its nature and management, 2nd ed. Oxford, Oxford University Press, 1987. Outcomes Nonfatal suicide attempts can result in serious injury. 300,000 (or more) Americans survive a suicide attempt each year. While a majority sustain injuries that allow them to be released following emergency room treatment, a significant minority—about 116,000—are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 10 days and the average cost is $15,000. Seventeen percent, some 19,000, of these people are permanently disabled, restricted in their ability to work, each year, at a cost of $127,000 per person. See also *Suicide behaviour *Multiple suicide attempters References Further reading Key texts Books Papers Hirsch SR, Walsh C, Draper R. Parasuicide: a review of treatment interventions. J Affect Disord 1982;4:299–311. Additional material Books Papers *Google Scholar External links Category:Behavior disorders Category:Self destructive behaviors Category:Suicide Category:Parasuicide